According to a World Health Organisation definition, "sex" refers to the biological characteristics that differentiate humans as females and males. However, these characteristics are not mutually exclusive, as there are some individuals who possess both female and male characteristics.
The term sex, when used commonly, often means "sexual activity" in many communities globally.
"Sexuality" is a central aspect of being human throughout life. It includes sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction.
Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles and relationships. Not all aspects of the various facets of sexuality are always experienced or expressed. It is influenced by biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious and spiritual factors.
It is generally accepted that sexuality begins at or soon after birth. Infants feel the warmth, closeness and pleasant sensations when they are carried by their mothers especially during breast feeding.
Small boys often get erections, especially after seven years of age. However, sexuality does not involve the genital organs only. It is part of everything that a person is. That is why many young people identify with someone they admire, including celebrities, parents or teachers.
Although most children do not become sexually active, like adults, until they reach puberty, it is important to remember that the foundations of sexual development and sexual health are laid in childhood.
All children learn how to interact with others and develop socially acceptable behaviour. Gender identity and gender roles develop during childhood. The understanding of relationships and development of values in early childhood are the foundations of the development and evolution of sexuality as children grow up.
Parents and caregivers are the primary sexual health educators for children, from the time they are infants and toddlers. As children grow up, they also learn about sexuality from other family members, play and school mates, and people in the world around them. While initially age-dependent, the rate and nature of sexuality development vary considerably from child to child.
At puberty, there are many physical and hormonal changes which awaken sexual feelings in different ways. The changes involve the body and mind of adolescents who wonder about new and often intense sexual feelings.
Adolescents encounter enormous pressures with respect to sex and sexuality. The messages they receive are often conflicting. On the one hand, sex is seen from a negative perspective and associated with fear, guilt and disease.
On the other hand, peers and the media portray it positively and often as desirable. This is often compounded by a lack of accurate information, skills and awareness of their rights, notwithstanding the sex education that they are supposed to receive in school.
Most, if not all, adolescents need time to understand who they are and who they are becoming, including their sexual feelings and attractions. Peer pressure and media focus, however, often do not give them enough time to do so.
Society's shortcomings in meeting the emotional, social and health needs of adolescents and young people in respect of their sexuality is reflected in the increasing numbers of sexually transmitted infections including HIV/Aids, unwanted pregnancies, sexual abuse and suicides. It is sad that many opinion leaders still have simplistic explanations and solutions for such complex issues.
Sexuality during the reproductive years does not pose many problems relatively. However, they may arise when there is ill health, after menopause and in senior citizens.
Senior citizens with positive attitudes view sexuality as an affirmation of physical health, an expression of affection and loyalty, a continuing opportunity for growth and experience, and a maintenance of identity and self-confidence.
The negative stereotype of senior citizens is that of desexualised invalids at one extreme or "dirty old men" or "lecherous old women" at the other. Some senior citizens, who are physically healthy, may have such a view of themselves. This is reflected in the refusal to associate with fellow senior citizens and attempts, often futile, to appear inappropriately young.
Sexuality in senior citizens is affected by common problems in the age group, i.e. medical disorders, ill health or death of a partner, access to friends and relatives and lack of accurate information about sex and sexuality.
Sexuality does not have an age limit. Many men and women continue to have a satisfying sex life when they get older. There is no reason why sex should not continue into the 70s or 80s.
Sexual orientation
This refers to the gender that a person is attracted to. There are different types of sexual orientation:
Heterosexuals are romantically and physically attracted to members of the opposite sex, i.e. male to female and vice versa. They are sometimes called "straight".
Homosexuals are romantically and physically attracted to people of the same sex. Females attracted to other females are called lesbians. Males attracted to other males are called homosexuals and are often known as gay. The term gay is sometimes also used to describe homosexual individuals of either gender.
Bisexuals are romantically and physically attracted to members of both sexes.
Adolescents often have sexual thoughts and attractions, some of which may be intense, confusing or disturbing, particularly when they involve someone of the same gender. It is important to remember that having sexual thoughts about people of the same or opposite gender does not necessarily mean that one has a particular sexual orientation.
A person's sexual orientation is a reflection of his or her sexual and emotional feelings towards people of the same or opposite gender. By the time one reaches adulthood, one should have a pretty good idea of what one's sexual orientation is.
Many doctors believe that sexual orientation involves a complex mix of biology, psychology and environmental factors. There is strong evidence that homosexuality is more common in certain families, even when the children were given up for adoption, indicating that genes play a role in its development. The hormonal environment in the womb too may have an influence on sexual orientation later in life.
There are scientific studies that challenge the view that homosexuality is a lifestyle choice or sexual preference, and that it is "pre-determined". However, there are many who disagree.
It is likely that the genesis of a person's sexual orientation is not yet completely understood.
The Health Ministry's Third National Health and Morbidity Survey in 2006 reported that, among Malaysians who revealed their sexual orientations, 95.8% were heterosexuals, 2.2% were bisexuals, 1.1% were lesbians and 0.9% were gays.
In conclusion, it is important to distinguish sex from sexuality. Whereas the former refers to biological characteristics, the latter encompasses what is human and extends across the ages. Sexual orientation is a complex mix of nature and nurture, the origins of which are yet to be completely clarified.
-Dr Milton Lum is the chairman of the Commonwealth Medical Trust. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.
The Star/Asia News Network
This story was first published in The Star on Sept 17, 2008.
